Toxicology: cocaine-associated chest pain: practice question

A Pharmacology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pharmacology · Toxicology: cocaine-associated chest pain

Sample item

A 28-year-old man presents agitated and sweating 30 minutes after using cocaine, with central chest pain, pulse 124 per minute, blood pressure 175/105 mmHg and ST depression on the ECG. Which drug is the best initial therapy?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Intravenous benzodiazepine

Cocaine blocks catecholamine reuptake, causing sympathetic overstimulation with coronary vasospasm, tachycardia and hypertension. Benzodiazepines reduce central sympathetic drive and are first-line, with aspirin and nitroglycerine added. Beta-blockers are avoided in the acute phase because unopposed alpha stimulation can worsen coronary vasoconstriction and hypertension.

Option by option

  • A. Intravenous adenosine

    Adenosine treats supraventricular tachycardia, and this sinus tachycardia is driven by sympathetic excess.

  • B. Intravenous propranolol

    Propranolol leaves alpha-mediated coronary and peripheral vasoconstriction unopposed.

  • C. Intravenous benzodiazepine (correct)

    Benzodiazepines reduce central sympathetic drive and relieve vasospasm and tachycardia.

  • D. Intravenous alteplase

    Thrombolysis is for proven ST elevation myocardial infarction and carries bleeding risk with severe hypertension.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Pharmacology question

What is the answer to this Pharmacology question?

The best answer is C, Intravenous benzodiazepine. Cocaine blocks catecholamine reuptake, causing sympathetic overstimulation with coronary vasospasm, tachycardia and hypertension.

Why is "Intravenous adenosine" not the answer?

Adenosine treats supraventricular tachycardia, and this sinus tachycardia is driven by sympathetic excess.

Why is "Intravenous propranolol" not the answer?

Propranolol leaves alpha-mediated coronary and peripheral vasoconstriction unopposed.

Why is "Intravenous alteplase" not the answer?

Thrombolysis is for proven ST elevation myocardial infarction and carries bleeding risk with severe hypertension.

What concept does this question test?

It tests Toxicology: cocaine-associated chest pain in Pharmacology. Benzodiazepines reduce central sympathetic drive and are first-line, with aspirin and nitroglycerine added. Beta-blockers are avoided in the acute phase because unopposed alpha stimulation can worsen coronary vasoconstriction and hypertension.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Toxicology: cocaine-associated chest pain?

Learn drugs as classes, then the exception in each class that an examiner would pick. Then use the flashcards and the other Pharmacology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.